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Home My Public Portal About6418 TRELAWNEY AVE_Building__ DEPAST OF B nING AND SAFETY APPLICATION FOR PERMIT �^ E\PAR=' of Loi Ai4cELE8 AUG 1 11948 BUILDING MIM. J. FOX, CHIE► LNOIN[ER -APPLICANT TO FILL IN FOR OFFICE USE ONLY SWLDINO DISTRICT NO - — PLANCK NO -- PERMIT NO ADDR[BB 7,(o v- i R N ¢.q t 2 1 LOCALITY u r i E .R[D[Ivm BY DATE Or APL own leeu[D 1 oEAREer c- -/oar Le • e dw OWNER LDINIII S ADoOWNER AMAIL LoDAL1TY e4N Gd DCR® NLAREBT TELNo. i Ar CROBSBT FIRE NO.OF TYPE GROUP_I— ARCHITECTOR T[L ZCNE PLANS �(� [NOIN[ER 6X76 0. BDG ONO ADDRESS B[ S r I' / o APPROVED - CONTRACTOR 4 e L C L 6 �l r BY DATE IL� USE APPROVED ADD ZONE BY in DAT[ L[CAL 44 CORRECTIONS DESCRIPTIONN4 e K TRACT a o 4( o - ,,AA y �^1 / NO OrB Go SIZE OF LOT W/� ^ WON L= GT DT I NO Or • I NO or OCSTIM0 SLD G. FAM"IO ROOMS _ _^ DESC OTION OF WORK „a NEW I ki—ALTERATION I I ADDITION - -- O REPAIR MOVING DEMOLISH _ p BD F NO Or SIZE ROOMS STORIES WALL ROOr COVERING COVERING uS[Or N BUILDINGve CZr i 1HERESY AOKNOWLEDO[ THAT 1 HAVE READ THIS APPSOviii APPLICATION AND STATE THAT THE ABOVE IB CORRECT rOUNDATIONI LOCATION BP[OTOR DAT[ AND ADR[[ TO COMPLY WITH ALL COUNTY ORDINANCES rORMS.MAT[RIALB Z, AND STATE LAWS R[Ol1LATINO BUILDIN06DNSTRUCTION rRACI rITPB, BIGNATUREa► JBRACING.NOLTe PERMITT[ LATH.INT.1`QL AUTHORIZED AOT LATH.OIT.t I'l^1.�^ i oee-a Iwmt t-+S $ P O B �Q PLASTER.INT. 81`.5 DO. �� ' — PLASTER.KEY. FINAL VA WATION R[ Q y [D3 1/71 dtt7 APPLICATION TAPPLICATION FOR BUILDING ERMI j • ( COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING ADDRESS COLEMAN W JENKINS, SUP T Or BUILDING LOCALITY FOR APPLICANT T FILL 1N NEAREST Pr nt onl CROSS ST BUILDING / CIAw�f DIS TRIGT N G UP ITYPE CONST R BY ADDRESS ` pV� STATISTICAL CLASSIFICATION SEWER P LOT NO BLOCK CLASS NO DWELL UNITS_ BK P TRACT 7 a USE ZONE MAP �a O 3 NO OF SLOGS NO S1ZE OF LOT NOW ON LOT SPECIAL USE OF CONDITIONS EXISTING BLDG A W�« TEL OWNER . 0,czlrou NO BLDG SETBACK FROM ADDRESS `,A X-7 FRONT PROP LINE OF (STREETI TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL CITY HIGHWAY WIDTH FROM C L ARCHITECT OR TEL + _ ENGINEER NO BLDG SETBAC ROM ADDRESS yy/ SIDE PROP LINE (STREET) //I/ NOL 0 IGHWAY WIDTH OTOF IHO PROM C L HIGHWAY } YARD = TOTAL CONTRACTOR AODRESS//I;jNICK#7SIC YA NO2 44I + _ CD CITY G r O CLASS O CORNER CUTOFF YES ❑ NOCONS ❑ RUCTION LENDER NAME TAND BRANCH A v,`e = ♦ SEE REVERSE SIDE FOR SPECIAL APPROVALS ADDRESS Q7Q /` .O�J e jw 1- tel rf� ^7 N ^ t^/ Pr/�MiT SO FT A NO OF NO NEW OF S1ZE / STORIES FAMILIES USE OF , STRUCTURE 6 40An� 1 Q ou goTER F) �^ O ` i�R-f`�/ SA /1 �/ b..I. - r- i M' REPAIR❑ 1 SIGNATUR O AFo n Al XT& Ao Vco �K.a APPLICANT // E OEMOL ❑ VALUATIONS (p Q O NOW APPROVALS DATE INBP[c Toe•s nGKA TV Rc P C PMTFOUNDATION LOCATION Q/ i FEE 5 FEE S�JFORAS MATERIALS /�j / FRAME FIRE STOPS I HER!!Y ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS AND [TATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITH ALL ORDINANCES AND LAW! REGULATING BUILDING CON- GAS VENT DUCTS STRUC TION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH INT LABOR CODE OF TV STATE OF CALIFORNIA IN RELATING• WORKMEN 3 COMPS TIO INSURANC! LATH EXT SIGNATURE OF HOUSE NUMBER COR- PER MITT E RECT AND POSTED A CORE Ss /�•�uR� �r FINAL JOHN F LEWIS PRINCIPAL ST RAL ENGINEER PLAN CHECK VALIDATION CK MO CASH _ PERMIT VALIDATION CK .0 CASH s 6 ?C JLLG7 1 D 5 5.50- = TSAGSBACE?CSDS logo APPLICATION FOR BUILDING PERMIT 1 B=DiG AND SAFETY BUILDING BUILDING hi ADDRESS Depaetmmt OJ Cauaty EBgloaar //`` County of LGE ADgelw LOCALITY / `+ JOHN A LAMBIE. COUNTY ENGINEER NEAREST CASSATT D GRIFFIN SUP T OR BUILDING CROSS DISTRICT- GROUP TYPE SEWER MAP FOR APPLICANT TO FILL. IN � —p- _ BK CONST BUILDING / Lllb ADDRESS 6q /(D OE L A\V STATISTICAL CLABBIFICATION LOT NO S I G O O / BLOCK CLASS NO DWELL UNI,B STATE MAPNUMBER TRACT Q Q HWY Y88 USEZONE SPECIAL NO OR SLOGS CONDITIONS SIZE OR LOT O (► J I NOW ON LOT �l I USE OF I� Et INC LDG BUILDING EXIST SETBACK YARD HWY STREET NAME WIDTH OWNER I FPROINT 10 1:1, G G O / MAIL �NI 1 ADDRESS ` SIDE TELIT t P L INSPECTION RECORD ARCHITECT OR T L ENGINEER O ADDRESS TEL G CONTRACTOR NO / Mew ADDRESS / DESCRIPTION OF WORK AZZ, o ND c NEW ADD ALTERDEMOLISH H ,/O SO FT NO OREP /� _NO OR /� Y SIZE RIES AMIL / USE OF U URE APPROVALS SIGNATURE OR APPLICANT DATE INSPECTOR S SIGNATURE ADDRESS FOUNDATION LOCATION _/L FORMS MATERIALS J FEH S �^ FRAME FIRE STOPS. BOLTS -7 BRACING BOLTS GILI VALUATION FRR S Z v RGAS VENT DUCTS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH INT PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY O DINANCES AND LATH EXT STATE LAWS RE LAT G 1 IN6 NSTRUCTION SIGNATURE OR OUSE NUMBER COR- PERM I7TEE RECT AND POSTED ,�•s,� ADDR FINAL 12—3 S/q !/f'/ LL�JL(�.U� JOHN A LAMBIE, COUNTY ENGINEER, CLYDE N DIRLAM PRINCIPAL STRUCTURAL ENGINEER PLM CHECK VALIDALOR OK MO CASH PERMT VALMU OR CK Flo wH LAAO 2 2.1 3fn SEP 12 1 2.00 9 0 DEPARTMENT OF NUUMMG AND SAFETY APPUCAnON FOR PEHNIIT COUNTY OF LOS ANGELES I L D I I tl G WM J FOX, CHIEF ENGINEER e FOB APPLICANT TO FILL fI7 FOR OFFICE USE ONLY BUILDING DIBTIIICT NO PLAN CK NO PERMIT NO ADDRESS • R!ClIV®BY LOCALITY DATE OF APPL DATE I UED fir NEAREST ^ Zr CROSSST BUILDNBG OWNER ADOR ' ��r1!N 4 AE MAIL LOCALITY / C./ ADDRESS NEAREST .�� CROSS ST CITYNO FIRE NO OF 1 Type 6ROUP�� ARCHITCCTOR TEL. SONE PLANS ENGINEER NO BLDG ORD NO SETBACK LINE ADDRESS APPROVED TEL BY DATE CONTRACTOR NO USE APPROVlD ZONE 1 SY DATE ADDRESS Houpg NUMBERING LEGAL DESCRIPTION LOT NO BLOCK MAP NUMB IELD CHICK BY TRACT NO ASSIG BY 1 DAT NO OF BLDGB COHBECTIONS SIZE OF LOT NOW ON LOT U89OF n^ I NO OF a ISTING 81 DO ]� FA81LJu DESCRIPTION Cgr WORK NEW ALTERATION I ADDITION O R�AIR DEMOLITION '9 P_ 80 FT NO OF SIZE ROOMS ^*^RIES Z m[T WALL ROOF » / r COVERING Q7✓� COVlRING USE OF STRUCTURE APPROVALS + INSPECTOR'S SIGNATURE DATE 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AR FOUNDATION LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS MATERIALS CORRECT - 1 AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME FIRESTOPS, �1{{ER[ON AND WITH ALL COUNTY ORDINANC AND STATE BRACING, BOLTS LAWS REGULATING BUILDING CONST UCTIO FURNACE LOCATION, SIGNATUREOF GAB VENT, DUCTS PERMITT ADD G LATH, INT LATH, m(T AUTHORIZED AOT PLABTER, INT 7"U" RIW 10.80 s P C E 0 PEQ PLASTER, EXT VALUATION FEE "Z�SO FINAIMAXIMUM C APPLICATION FOR COUNTY OF LOS ANGELESTY ENGI DEPARTMENT OF COUNNEER IIUILDING PERMIT BUILDING AND SAFETY DIVISION U UILDING FOR APP ICANT TO N ADDRESS BUILDING / ADDRESS LOCALITY NEAREST CITY ZCROSS ST NL, OFASSESSOR S1ZE OF LOT NOW OMAP BOOK PAGE PARCEL DISTRICT OU TOPE FIRE SSED BY TRACT BLOCK �[,"r„/J CONST ZONE 1 }}�� J `OWNER YLSTATISTICAL CLASSIFICATION/ SEWER P ADDRESS - V CLASS NO, )/DWELL UNITS BK PG CITY (� ZE ZONr�ARCHITECT OR _ _I� SPECIALENGINEER Y� CON OI TNSADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NOCONTRACTOR Or1 BLDG SETBACK FROM ,3 r� I FRONT PROP LINE OF (STREET) qjE2ADDRESS u 4_ *_ '7 HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING CITYFRONT PROP LINE HIGHWAYTHSS CONST U TON LENDER + NAME AND BRANCH BLDG SETBACK FROM O ADDRESS CITY SIDEPROP LINEOP (STREET) C� SO FT NO OF NO OP CHECK HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING C SIZE STORIES FAMILIES ONE SIDE PROP LINE HIGHWAY WIDTH DESC TION OF WORK NEW + = N \ DD ❑ CORNER CUTOFF YES ❑ NO ❑ z ALTER ❑ IN OPEN SPACE YES ❑ NO ❑ EPAIR❑ USE TI /� IN COASTAL PERMIT ZONE TES ❑ NO ❑ EXISTING BLDG F�`, � EMOL APPLICANT TEL G� ��..� ax 3- zq- 77 (PHI NT) NO BY (SIGNATURE) I HEREBY ACANOWLEDOE THAT I HAVE READ THIS APPLICATION AND !TATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAW! REGULATING BUILDING CON• lT RUC TIOM I C[RTI IY THAT IN DOING NO THE WORK AUTXORIILD HlRCDT 1 WILL NOT EMPLOY ANY P[RDON IN VIOLATION OF TNC LABOR COD[ OF THE CTAT[ 0I CALIFORNIA IN RELATING TO WORKMEN ! COM NtA TION PMD URAN C SIGNATURE OF ��L FINALC j �� / BY PERMITTEE DATE /Vl+ ADDRESS J TEL PC Fae S < 6 Permit Fee CITY [P� NO t( Issuance Fee VALUATION Y Total Fee Z• Z� PLAN CHECK VALIDATION CK ^o CASH PERM VALIDATIO CK M o SASH 5 i n � D (7 -w 40G tt j 5 a ]tAtttA CK0110313 1 �' O L9s 78""A n APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDING41 BUILDING ADDRESS ADDRESS LOCALITY NEAREST CITY ZIP CROSSST NO OF BLDG ASSESSOR SIZE OF LOT O Z NOW ON LOT MAP BOOK PAGE PARCEL q DISTRICT GROUP TYPE FIRE P ED BY TRACT / BLOCK - ' LOT NO ,/B CONST 7D�IE TEL s'^0 8 `�-3 V e.7 OWNE NO rPCF"$ ICAL CLASSIFICATION LL_ EWER MAP ADDRESSgle S NO DWELL UNITS G BK3 PG CITY ZIP A I TEL ION $ ,/SDENGINEER NOll//ADDRESS ETBACK FROMTEL ROP LINE OF (STREET) CONTRACTO OTOTAL SETBACK FROM TYPEOF EXISTING LIC AY + YARD FRONT PROP LINE HIGHWAY WIDTH ADDRE NO S'ZIIC +CITY /Q CLA55CONSTRU 1 N LENDER ETBACK FROMNAME AND BRANCH P LINE OF (STREET( AY + YARD TOTAL SETBACK FROM TYPE A EXISTING 0ADDRESS CITY $IDE PROP LINE HIGHWAY WIDTH OSFT NO OF NO OF CHECK +SIZE STORIES FAMILIES ONE 0DESCRIPTION OF WORK NEw E Permit Fee /..) i / EI7G� K ADD Issuance Fee ALTER j,&Kf4jt 'Waal. REPAIR ❑ Total Fee USE OF DEMOL Cl EXISTING BLDG ,I 4 S A Z APPLICANT EL IPRIN �t O 0 Q O BY(SIGNATURE( > ;93022A I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES qq AND(AWS REGULATING BUILDING CONSTRUCTION 1 CERTIFY THAT IN MING THE S X WORK AUTHORIZED HEREBY I WILL NOT EM OY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM 21* A 2 2 0 Q PENSATION INSURANCE SIGNATURE OF E - - 2 2 0 00 PERMITTEE T 0 a O 2T-7 9 SZI�AX ADDRESS TEL r OPSP.EC��IAL TZINDITIONB BV APPLICATION FOR BUILDING PERMIT 1 DrMON OF BUILDING AND SAFM BUILDING Dopmbnon1 of� Fa� ADDpEBB C2 14gaLe4d COmV OI LOB ADgBLs LOCALITY WM J FOX COUNTY ENOINER NEAREST BN/� CASBATT D GRIFFIN.SUP TOF BUILDING C ST FOR APPLICANT TO FILL IN DIPTryQ NO. ORO ► r. • BK wil MAP T .L/ r ADDER BUILDIN O. / L MAP STATS NUMBER HWY YES O LOT NO ' BLOCK P UBR ZON/E SPECIAL CONDITIONS TRACT / 2-70 &P *Re OF LOT Q A y G NO OF SLOGS / BUILDING EXIST NOW ON LOT SETBACK YARD HWY STREET NAME WIDTH UBR OP FRONT EZI B PR LN /v OWNER SIDS P MAIL ADDRESS O TRACT DWELL I UNIT S INDUSTRIAL TE. I DWELL 1 UNIT cITY 6 PUBLIC BLDG ARCHITECT OR TEL 2 DUPLEX 1 UNIT 7 DN ALT RC ENGINEERNO 9 APT _UNIT ADDRESS 014a:K e Mlseln. 4 OoMMROUI TEL CONTRACTOR od NO INSPECTION RECORD ADDRESS DESCRIPTION OF WORK Cob i 1✓Itt N AD ALTER REPAIR DEMOLISH F_Gav SO PT NO OF NO OF SIZE STORIES FAM 118 USE DolTRUCTU 8 J QIT/1 ONATURE OF APPLICANT APPROVALS ADORES* DATE INSPECTOR'S 91GRATURE FOUNDATION a e G P C • Pon", MAT ROCL; �I �(/ V PR FRAME FIRE STOPS VALUATION • BRACING BOLTS FM FURNACE LOCATION. 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GAS VENT DUCT* APPLICATION AND STATE THAT THR ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH INT AND *TATE LAWS REGULATING BUILDING CONSTRUC• TION. LATH MIT. SIGNATURE OF L HOUSE NUMBER COR- PRYYITTM[ R[CT AND PORTED ( ADDRESS FINAL QLJ WM.J.FOX.COUNTY ENGINEEM VALIDATION C. N.DIRLAM.CHIEF BLDG. INSP•CTOR M2717ZR FM10 1 400 In WORKERS'COMPENSATION DECLARATION- • �I 1 hereby affirm that I have certificate of consent to .elf APPLICATION FOR BUILDING PERMIT LI'S insures, or a certificate of Workers' r' Coke ' Compensation Insurance or a certified copy thereof (Sec 3WO Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY t Policy No Company - BUILDING / Certified copy Is hereby furnished FOR APPLICANT TO FILL IN ADDRESS q Certified copy is hd filed with the county building Inapec- BUILDING on department LOCALITY e NEAREST Dote Applicant CITY ZIP CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS BLDGS ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed If the permit Is for one USE ZONE Al hundred dollars ($100)or less ) TRACT BLOCK LOT NO TEL 3'O_ RSPECIAL y I certify that in the performance of the work for which this OWNERb AxNO rCC CONDITIONS d permit Is Issued, I shall not employ any person In any mannerDISTRICT GROUP TYPE FIRE SSED BY O so ca to become subject to the Worker Compensation Laws ADDRESS ZIP U D 1 SSTs / ZONE O q o '\ J 1/ cc Date `�!" Y Appilcant Cin ' STATISTICAL CLASSIF TION APT ON NOTICE TO APPLICANT If cher making th s Certlhciste of - ENGINEARCHER OR I TEL NO - Exemption, you should'become subject to the Workers' CLASS NO DWELL UNITS_ d Compo Pt�n provisions provisions s�orC tide you must ashallnbe ADDRESS SEWER ANP W with coca with such deemed revoked CONTRACTOR t�j Lp BK PG VALIDATION LICENSED CONTRACTORS DECLARATION LIC NO I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS .3 e D NO VALUATION (commenang with Section 7000)of Division 3 of the&ninxass and LIC -219 Professions Code and my license s In full force and effect CITY U Y/ s L� CLASS f SO FT NO OF NO OF CHECK License Number4&-c �,47 Ed Llc Class � � / SIZE STORIES FAMILIES ONE // Contractor gd t en fl.Dme AV- -4 L/ DESCRIPTION OF WORK NEW ❑ $ 1 am exempt under Sac /- 5..6 ADD ❑ ALTER ❑ FINAL 8 8P C for this reason ❑ DATE REPAIR Dara USE OF EXISTING BLDG DEMOL ❑ FI Signature — APPLICANT TEL By OWNER-BUILDER DECLARATION PRIM NO I hereby offmn that 1 am exempt from the Contractor's License , 6 6 Q$ �,']��{ Law for the folfowmg reason (Section M31 5, Business and , r Professions Code) e e e e e BUILDI I, as owner of the property or my employees with ADDRESSNG tt , wages m their sole compensation will clothe work andL I e e 6$6 3 the structures not Intended or offered for sale(Section 7044, Business and Professions Code) MOVING TEL 6$ 636 I, as owner of the property,am exclusively contracting e e e with licensed contractors to construct the project (Sec- ADDRESS 'I Q03-84 tion 7044 Business and Professions Code) REQUIRED TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BAC( YARD MAN PROP LINE WIDTH ► I hereby affum that there Iso construction lending agencyfor FROM he performance of the work far which this permit is Issued P L (Sec 3097, Civ C ) SIDE _ b PL 3 Lenders Name $ PC Foeti; Permit Fee - Lender's Address I certify that I have read this application and sate that the Issuance Fee above Information Is correct I agree to comply with all County Investigation Fee ordinance and Sate jaws relating to building construction, Total Fee and hereby authorize representatives of this County to enter � upon) ahovs- enp �,rern�y for Inspection pnurposes o ! ( ' [/i' by J'Q M REVRN FOR EXPLANATORY LANGUAGE - e Signotwe of Applicant w A: Dote 4% I v WORKERS COMPENSATION DECLARATION hereby affirm that I haver certificate of tion Intuta ,elf• t APiPLICATION FOR BUILDING PERMIT insure or a certificate of Workers' Compensation Insurance, � / or a certified copy thereof (Sec 3800 Lab C ) Policy No Company COUNTY OF LOS ANGELES BUILDING AND SA5TY yG Certified copy is hereby furnished BUILDING FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec- tion departmentADORES$ M Q p ✓eJ LOCALITY t J' NEAREST Dote T Applicant CITY Ten ZIP CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS 1 / OF BLDGS ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE Z QO hundred dollars ($100)or less ) TRACT BLOCK LOT NO SP ECIAL 1 certify that in the Performance of the work for which this OWNER U M be— CONDITIONS d permit is issued I shall not employ any person in any manner - // QI DIS ICT GROUP TYPE FIRE PROCESSED BY O w as to become subject to the War n Compennssaation / ADDRESS h � S Z_� a-w rte /�61e ./� CONST Z U Date Applicant /v/� CITY / �ITECT�Yr.[- l L 1 ZIP l sJ STATISTICAL CLASSIFIUTgN APT COPDO O NOTICE TO APPLICANT If, affe okmg this Certificate of A. � TEL - uVi Exemption, you should become subject to the Worker ENGINEER NO CLASS NO DWELL UNITS IL Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP N with comply with such provisions or this permit shall be � ? deemed revoked CONTRACTOR NO TEL BK PG 3 VALIDATION LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that 1 am licensed under provisions of Chapter 9 ADDRESS NO VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC Professions Code, and my license is in full force and effect CITY CLASS f L(/ ► SO FT NO OF NO OF CHECK License Number Lic Class SIZE STORIES =10UES ONE Contractorpate DESCRIPTION OF WORK L " / NEW ❑ f INI am exempt under Sec a. I.I.G�/�� 6/ of /^`'c'� ADD ,k_ ,6C7%ifC s9 i(�E�/t70'�I ryQ W TER ❑❑ DATE (i B&P C for this reasonFINAL PAIR Dote USE OF EXISTING BLDG MMCL ❑ BT Signature APPLICANT TEL OWNER-BUILDER DECLARATION PRIM NO I hereby affirm that I am exempt from the Contractor's License , Law for the following reason (Section 7031 5 Business and ADDRESS Professions Code) E] I as owner of the employees BUILDING property, or my emto ties with BUDDING wages as their sole compensation,will do the work and the structure is not intended or offered for sole(Section LOCALITY 7044 Business and Professions Code) MOVING TEL ❑ I as owner of the property am exclusively contracting CONTRACTOR NO with licensed contractor to construct the project (Sec ADDRESS tion 7044, Business and Professions Code) REQUIREED TOTAL SETBACK FROM EXIST r CONSTRUCTION LENDING AGENCY SET BACJ( YARD ' PROP LI WIDTH ► 3 5 5 0 A I hereby affum that there a a construction lending agency for FROM the performance of the work for which this permit is issued PL ,Sec 3097 Civ C ) BIDE m PL - 2 • • 7 8 0 0 Lendx s Name • • . 7 $ C 0 mu fd Lender's Address P C Fee f Perms Fee O P 17-84 7_84 I certify that I have read this application and state that the Issuance Fee 62 obove information is coned 1 agree to comply with all County Investigation Fee ordinances and State jaws relating to building construction, Total Fee and he by outhorize representatives of this County to enter upon above-me/ns�j�/^/Jed Hy for inspectiioon urposes •V'e- (J SU W@f!Fq EXPLANATORY LANGUAW n of Applicant or Agent Dora l APPLICATION FOR-BU D NO PERMIT COUNTY OF LOS ANGELESe • BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO RLL IN auw1NG b hereby firm that I have a certif lar,It corasnt to 10 Insure BUILOI �_- «a oertlBcat,of ylUrksre'Compensation Insurance,«a ' atl owy CA ato UBfe01(�Lebl� CITY Pok � { yC«npenY 1 O LOCALITY O 11 cetifled KKar M hereby furnished SIZE OF LOT NO OF ON S NEAREST L,Q,p•a h Av`� ❑ Carfifled Copy 11 filed with the County bulldlrg sapection TRACT BLOCK LOT NO department C 6 1 A... USE ZONE Date�,., pp„fa,H G[1,r7 R�LJI'.'v.I ASSESSOR k41P 11WK _ I'AOE nmr .� / c1ALcanrorrloNs CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER ICOTEL. Y® No IO COMPENSATN INSURANCE ADDRes , _ w i-iiN rood FT OF BC4OOL7 (TMs Mahn need not be completed If the permit Is for one hundred 4ull DISTRICT GROUP TYPE OONST FIRE ZONE RiOCES9m 01' dollars($100)«IM) I oertty that In the perfornnance of the work f«which this permit Cm CA ZIP NO 1 () �- Ik Issued I shalt not employ airy person In a"mann«so es to ARCHITECT CffI]NOWE731 Ta- bsoona subject to the Nbrkers'Comp«tstim Lawn yew STATISTICAL CLASSIFICATION APT CONDO Data Appitcant CLASS NO G; L DWELL UNITS ju NOTICE TO APPLICANT If. after making this Certificate of poissfflvCA WED TOTALSETBACKFROM F7t1ST Exemption you should become Subject to the workers' INtON CONTRACTOR I SETBACK YARD HWY PROP LINE WIDTHCompensation provleu«a of the Lobar Code, you Flret forMIWMcomply with such prvde{oma or flits pamnK siati be deemed revoked JU7%+i LICENSED CONTRACTORS DECLARATION PL I hereby a1Ponl that I em licensed under provisions of Capter B7V-6 SEWER MAP STORES NO OF FAYILIE9(commencing with Section 7000)of DNlsion 3 of the Busineee end 7z INEW ❑ BK vG , oLltense uN mbar Profeworm Code and Aly IKeras le LJc C.Iaee orce amid afiecl , VALUATION—VADD ..-� aL C«Ibecpor 2�2 0� ALTER ❑ ; Zm+00� s z F ❑ 1 an exempt under Sec REPAIR 11 $ B BPC for thle reason pp DENIOL ❑ IDWA PICS Data L Cyv ti ❑ Signature a APPLICANT(PRINT? LDMA Penn 0 ❑ 1, ere ower of the p y « my wfih ee as F� µ O - their sole compensation,will do the work end the is ADDRESS not intended «ORared f«sale (Section 7044. end 1%U OAA kat, FINIAL DATA ✓�� -' i� _ I Professions Cede) WILL APiLGVlian Funm elA TArDLaANASAPZE60A Ti. ❑ 1 Be ower of the am exclusively OR A Summa COxrAnw A MAT HUN-EQUAL To on oA U(PIR T property , project c(Sects ng with TmH;ArKLAnna�+csLm aT Caromwooca mrArouae sAasmxroKamAOn FasAl By > project (Section 7044 i Ilcensed contractors to construct the wy❑ �❑ n_-T.a Buelmleae and Rofeeelons Code) Sumo TTE vNrvttt use«Tia;euanst m TIE ArxKurr ere rurLne aueuwo '-I_, LLI;c -- CONSTRUCTION LENDING AGENCY cQuer,mo,or101�A"�roAorll ^DISTFU T(SC`0110)Seasr^vlONTNG CHECKLIST - I hemaby afftrm Mat tare Ins a CaratrucOM larding agency f« ria❑ mo❑ _ - y the performance of the work for which this Parmh Is blued(Sec lm ! _ -✓^ = AT--'�i- m mord READ Tow ILArAnoOLa wTEwAs mNFd1WaDN Door Arm Tre eoAm ' 3087 CYv C) reeLmvq LHLxaer L LaDB6rlilt w REOU�rte LaaY11 Tie LDB ANOEl® /' I: Lwdee Nex mwrasnrsa+mTSHlTtm+ecaTcovo+a � -1E: c <'A�w�; = LentlsYs Addresso.»aamAHem I cw*that I have read this aWlastlon and sale Oat the shove information M con I agree to Comply with all county PC FEE PEFMT FEE Jj pO• �� / _ ordinances end State laws MMag to bulldkg comWuction.end O1 hereby suthorbe rlpe/enfativse of this CaKdy to enter upon ISSUANCE FEE a the abMismentio ed property for Inspection purposes WVESTIOATrON FEE TOTAL FEE ZL le D pr..da .A mr 7 WE REVERSE FON EXPLANATORY LANGUAGE